U.S. patent application number 10/312629 was filed with the patent office on 2008-07-17 for anti-slip protection device for a housing head of medical instruments.
Invention is credited to Alexander Von Fuchs, Peter Kratky.
Application Number | 20080172087 10/312629 |
Document ID | / |
Family ID | 7647066 |
Filed Date | 2008-07-17 |
United States Patent
Application |
20080172087 |
Kind Code |
A1 |
Fuchs; Alexander Von ; et
al. |
July 17, 2008 |
Anti-slip protection device for a housing head of medical
instruments
Abstract
The invention relates to an anti-slip protection device for a
housing head (21) for medical instruments (20), especially
intraluminal instruments (20) for resection or anastomosis
operations, comprising a terminal device (2) which can be fixed to
the housing head (21) in such a way as to project out and which can
be remote-controllably removed from the housing head in at least
two sections (3, 4).
Inventors: |
Fuchs; Alexander Von;
(Salzburg, AT) ; Kratky; Peter; (Stamberg,
DE) |
Correspondence
Address: |
KLAUS J. BACH
4407 TWIN OAKS DRIVE
MURRYSVILLE
PA
15668
US
|
Family ID: |
7647066 |
Appl. No.: |
10/312629 |
Filed: |
June 28, 2001 |
PCT Filed: |
June 28, 2001 |
PCT NO: |
PCT/EP01/07375 |
371 Date: |
September 25, 2003 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
|
09629740 |
Jul 31, 2000 |
6446044 |
|
|
10312629 |
|
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Current U.S.
Class: |
606/213 ;
606/153 |
Current CPC
Class: |
A61B 2090/08021
20160201; A61B 17/115 20130101; A61B 17/1155 20130101; A61B
17/00491 20130101; A61B 2017/00849 20130101; A61B 17/1114 20130101;
A61B 2017/00336 20130101; A61B 2017/00495 20130101 |
Class at
Publication: |
606/213 ;
606/153 |
International
Class: |
A61B 17/08 20060101
A61B017/08 |
Foreign Application Data
Date |
Code |
Application Number |
Jun 28, 2000 |
DE |
100 31 436.8 |
Claims
1-17. (canceled)
18. A slide protection device for a housing head of intraluminal
instruments for insertion into a body lumen for resection or
anastomosis operations, comprising an egg-shaped terminal structure
disposed on the housing head of the intraluminal instrument so as
to project forwardly from, and cover, the housing head for
facilitating sliding of the intraluminal instrument into a body
lumen, said terminal structure comprising at least two cover
sections joined by releasable connecting means for retaining the
slide protection device on the housing head, at least one pulling
strip connected to each of the at least two cover sections of the
terminal structure, and means for remotely releasing the connecting
means so as to separate the at least two sections, said pulling
strips extending along the intraluminal instrument for retracting
the cover sections, after their release, past the intraluminal
instrument from the body lumen.
19. The slide protection device according to claim 18, wherein the
egg-shaped terminal structure consists of an elastically deformable
material.
20. The slide protection device according to claim 18, wherein each
of the at least two cover sections includes at least one fastening
structure for the attachment of the pulling strips to the
egg-shaped terminal structures.
21. The slide protection device according to claim 20, wherein the
fastening structure is a recessed eyelet.
22. The slide protection device according to claim 18, wherein the
housing head includes a pin with a conical front end to be driven
remotely between the cover sections of the terminal structure for
releasing the connecting means and disconnecting the cover sections
from one another.
23. The slide protection device according to claim 22, wherein the
at least two cover sections are symmetrical.
24. The slide protection device according to claim 23, wherein the
at least two cover sections have flat areas adjoining one another
when joined in place in front of the housing head and jointly form
a conical pin guide recess for directing the front end of the pin
between the cover sections in order to cause the release of the
connecting means.
25. The slide protection device according to claim 18, wherein the
cover sections have flat end faces seating on a front end face of
the housing head with contact foot portions extending from the
cover sections and jointly surrounding and engaging the housing
head.
26. The slide protection device according to claim 25, wherein the
contact foot portions are elastically deformable.
27. The slide protection device according to claim 18, wherein the
terminal structure comprises two egg-shaped shell sections joined
on the inside releasably by adhesive tape sections.
28. The slide protection device according to claim 27, wherein the
pull strips are bands firmly connected with their ends to the
inside of the shell sections and being provided with adhesive
sections forming the adhesive tape sections attached to the shell
sections for releasably joining the shell sections.
29. The slide protection device according to claim 28, wherein
between the firm attachment locations of the pulling bands to the
shell sections and their adhesive sections joining the shell
sections, the pull bands are folded at least once approximately at
right angles against the inner surface of the respective shell
sections.
30. The slide protection device according to claim 29, wherein each
shell section is provided at a circumferential area thereof, with a
recess sized so as to accommodate the respective pull band
extending from within the shell sections.
Description
BACKGROUND OF THE INVENTION
[0001] The present invention relates to a slide protection device
for a housing head of medical instruments, in particular
intraluminal instruments for anastomoses following intestinal
resections.
[0002] Although applicable to any form of intestinal anastomosis,
the present invention and the problems on which it is based are
described with reference to resection operations in the area of the
rectum.
[0003] In intestinal resection operations for treating benign or
malignant tumors in the area of the descending colon or sigmoid
colon or the rectum, the portion of the intestine carrying the
tumor is resected, the two disconnected portions of the intestine
are brought together and connected by means of a suture, for
example a purse-string suture.
[0004] This procedure is usually performed using what is called an
intraluminal circular clip suture instrument, which can be seen in
FIG. 1.
[0005] This kind of surgical procedure will be described below with
reference to FIGS. 1 through 5. A contact pressure device 27, which
has a receiving sleeve 28, is knotted into the proximal portion 30
of the intestine, as is shown in FIG. 2. The corresponding mating
piece is introduced through the anus, said mating piece consisting
of a housing shaft 22, a grip 23 with a rotation device 24, and of
a housing head 21 from which a connection pin 25 can be driven out
by means of the rotation device 24 in the direction of the axis of
symmetry of the housing shaft 22.
[0006] A cutting and clamping mechanism 29 is also provided in the
housing head 21 and can be actuated by means of a release lever 34
arranged on the grip 23.
[0007] After an operating surgeon has passed the housing shaft 22
with the housing head 21 through the rectum, the connection pin 25
is driven out by means of the rotation device 24, whereupon a tip
26 of the connection pin 25 bores through the center clamped distal
route portion 31, as is shown in FIG. 2.
[0008] Next, as is shown in FIG. 3, the receiving sleeve 28 of the
contact pressure device 27 is engaged with a form fit onto the
connection pin 25, with a spring device serving for a secure
contact.
[0009] Thereafter, as is shown in FIG. 4, the contact pressure
device 27 and the housing head 21 are pressed together by means of
the contact pin 25 being driven back into the housing head 21 with
the aid of the rotation device 24, and, after an indicated position
is reached, the cutting and clamping mechanism is released by the
operating surgeon pressing the release lever 34.
[0010] FIG. 5 shows the result of this surgical procedure, in which
in each case an intestinal ring of defined length is cut out from
the proximal portion 30 of the intestine and also from the distal
portion 31 of the intestine and is removed through the anus
together with the intraluminal instrument 20.
[0011] The problem on which the present invention is based is that,
in the surgical procedure described above, a large number of
patients experience postoperative difficulties in voluntarily
activating the sphincter muscle. These patients cannot therefore
correctly control their bowel movements.
[0012] There are principally two reasons for the occurrence of
these difficulties. First, the front circumferential edge of the
housing head 21, as it is pushed through the intestine, often
causes tears and thinning of the musculature of the internal
sphincter, and less commonly of the external sphincter.
[0013] In addition, as the intraluminal instrument is pushed
forward, the soft mucosa of the intestine, that is to say the
intestinal mucous membrane, in the inside of the intestinal portion
is pushed along by the housing head in the recess of the housing
head. The intestinal mucous membrane is thus stretched and is fixed
at the anastomosis area. The soft intestinal mucous membrane has a
tendency to draw back into the original position. As a result of
this stretching tendency, a reduced local perfusion, that is to say
an inadequate blood circulation, can occur in the anastomosis area.
This insufficient blood supply can lead to anastomosis
insufficiency, which represents a serious complication for the
patient.
[0014] Thinning and tearing of the intestinal serosa can also
occur, which also lead to considerable complications.
SUMMARY OF THE INVENTION
[0015] The object of the present invention is therefore to make
available a slide protection device for a housing head of medical
instruments, which allows these instruments to be introduced and
advanced through the intestine without damaging and pushing the
intestinal mucous membrane along with it, and which does not impede
the subsequent surgical procedure described above.
[0016] According to the present invention, the slide protection
device consists of a terminal device which can be secured on the
housing head in such a way as to project over it and which can be
removed from the housing head by remote control in at least two
sections.
[0017] Compared to the prior art, the slide protection device
according to the invention, with the features of claim 1, has the
advantage that both the recess and also the circumferential edge of
the housing head are covered by the terminal device, as a result of
which pushing of the intestinal mucous membrane and damage to the
musculature or the intestinal serosa are prevented. In addition,
upon reaching the portion of the intestine on which anastomosis is
to be performed, the operating surgeon can remove the slide
protection device from the housing head by remote control. Thus,
the slide protection device does not get in the way of the
subsequent procedures, for example the cutting and clamping.
[0018] The dependent claims concern advantageous developments and
refinements of the slide protection device specified in claim
1.
[0019] According to a preferred development, the terminal device is
round, in particular skittle-shaped or egg-shaped, with a flattened
end at one side. By means of this round shape, the coefficient of
friction can be greatly reduced and injuries in the inside of the
intestine can be avoided.
[0020] According to a further preferred development, the terminal
device is made of an elastically deformable material. Thus, on the
one hand, there is no risk of injury in the inside of the
intestine, and, on the other hand, it can be arranged on housing
heads with different diameters, which varies from 25 to 33 mm in
the instruments presently available.
[0021] According to a further preferred development, the terminal
device has, on each of the at least two sections, at least one
fastening device for a traction device on which a remote-controlled
traction device, in particular a tear-resistant cord, can be
arranged. In this way, an inexpensive possibility is afforded of
releasing the slide protection device from the housing head by
remote control and removing it outside the lumen from the
intestine.
[0022] According to a further preferred development, the fastening
device for a traction device is designed as a recessed fastening
eyelet.
[0023] According to a further preferred development, the at least
two sections are designed symmetrically. This has the advantage
that an unnecessarily large section does not have to be withdrawn
between the medical instrument and the stretchable intestine.
[0024] According to a further preferred development, the at least
two sections can be connected to one another via connection
devices, in particular predetermined break points designed as
plug-in bridges. Thus, the two sections can be connected to one
another in an inexpensive and straightforward way and can be easily
separated by application of a certain force.
[0025] According to a further preferred development, the at least
two sections each have flat areas which lie sealingly on one
another upon connection of the at least two portions. These areas
permit easy application of the force necessary for separation.
[0026] According to a further preferred development, each of the at
least two sections has, at the flattened end, at least one contact
foot which partially encloses to the outer circumference of the
housing head. These contact feet serve for additional guiding of
the terminal device on the housing head.
[0027] According to a further preferred development, the contact
feet are designed to be elastically deformable. Thus, even with
different housing head diameters, they provide optimum sealing with
the outer circumference of the corresponding housing head.
[0028] According to a further preferred development, the flattened
end of the terminal device has a hollow cylindrical
attachment/contact portion. This serves for easy attachment of the
terminal device onto a housing head. Since both the whole terminal
device and the treatment of the attachment/contact portion are made
of an elastically deformable material, simple attachment and
securing on housing heads with different diameters is
guaranteed.
[0029] According to a further preferred development, the
attachment/contact portion has a circular contact surface with a
conically designed spreader pin guide recess arranged at the
center. The conical design facilitates insertion of the connection
pin, driven out from the housing head, into the spreader pin guide
recess. In this way, the separation of the two sections is
permitted by a force application of the driven out connection
pin.
[0030] In a further embodiment of the invention, the two sections
of the slide protection device are designed as rounded cap parts
and are connected to one another via releasable traction band
fastenings. In this case, the end of the band is preferably secured
separately on each cap part, the traction band, between its end
fastening and the fastening connecting the caps, being folded at
least once approximately at right angles against the inner surface
of the cap part. Advantageously, the releasable traction band
connection thus affords a releasable connection of the cap parts,
which connection is formed by the traction band itself, and the
traction band, after being folded twice approximately at right
angles against the inner surface of the cap part, is then
preferably guided to an end fastening point which lies
perpendicular to the line of separation of the cap parts.
[0031] If, in addition, it is advantageously provided that the cap
part has an edge-side traction band guide formation near its end
fastening, it is possible to establish defined traction directions
for the removal of each cap part, the guide formation
advantageously being incorporated into an edge-side contact
formation preferably provided for each cap part for the housing
head.
[0032] This design permits simple separation of the cap parts and
removal after unfolding of the folded together band and thus the
release of the connection point between the cap parts.
DESCRIPTION OF THE FIGURES
[0033] Illustrative embodiments of the inventions are shown in the
drawings and are explained in more detail in the description
below.
[0034] FIG. 1 shows a side view of an intraluminal instrument with
an unscrewed contact pressure device;
[0035] FIGS. 2-5 show perspective views of a resection or
anastomosis procedure using the intraluminal instrument from FIG.
1;
[0036] FIG. 6 shows a front view of a slide protection device,
partly in cross section, according to one illustrative embodiment
of the present invention;
[0037] FIG. 7 shows a bottom view of the slide protection device
from FIG. 6;
[0038] FIG. 8 shows a diagrammatic view of a slide protection
device arranged on an intraluminal instrument during insertion into
a portion of the intestine;
[0039] FIG. 9 shows a diagrammatic view of a procedure of
separation and removal of a slide protection device from a housing
head according to an illustrative embodiment of the present
invention;
[0040] FIG. 10 shows a further illustrative embodiment of a slide
protection device with egg-shaped cap parts and traction bands
arranged on a housing head;
[0041] FIG. 11 shows an internal view of the slide protection
device according to FIG. 10 to illustrate the band fastening at one
end and the cap-connecting fastening by the traction bands; and
[0042] FIG. 12 shows a side view of the housing head according to
FIG. 4 in the first phase after opening of the cap parts.
[0043] In the figures, identical reference numbers designate
identical components or components with identical function.
[0044] FIGS. 1 through 5 show an intraluminal instrument 20 and the
individual steps of a resection operations performed with this
instrument. These figures have already been described in detail in
the introductory part of the description.
[0045] FIG. 6 shows a front view of a slide protection device 1
according to an illustrative embodiment of the present invention,
the left half being shown in cross section.
[0046] The slide protection device 1 shown in FIG. 1 consists on a
terminal device 2 with two sections 3, 4 which at their outer
connection line are advantageously connected to one another by
means of web-shaped plug-in bridges 5.
[0047] According to this illustrative embodiment, the terminal
device 2 is egg-shaped with a flattened end 15 at one side. A
contact foot 10 in the form of a semi-annular sleeve is formed
integrally on this flattened end 15, one for each section 3, 4.
[0048] Both the terminal device 2 and the contact feet 10 consist
of an elastically deformable material, advantageously of an
elastically deformable plastic. The two sections 3, 4 are each made
solid in the upper area and touch one another in the state inserted
in the terminal device 2 with the plane separating surface.
[0049] The terminal device 2 has, in the lower area, as can be seen
in the cross-section in FIG. 6 and in the bottom view of the slide
protection device 1 in FIG. 7, a hollow cylindrical
attachment/contact portion 12 for attachment of the slide
protection device 1 onto a housing head 21 of an intraluminal
instrument 20.
[0050] The attachment/contact portion 12 has a circular contact
surface 13 for contact to the end face of the housing head 21. The
annular contact surface 13 has a conically tapering spreader pin
guide recess 14 at the center.
[0051] Since both the terminal device 2 and also the contact feet
10 are made of an elastically deformable material, the terminal
device 2 can be arranged on housing heads 21 with different
diameters.
[0052] Provided on the outside of each of the two sections 3, 4,
advantageously in the lower area, there are two fastening devices 7
for a traction band which, in the present illustrative embodiment,
are designed as recessed fastening eyelets. A tear-resistant cord 8
is knotted onto each of these fastening eyelets 7.
[0053] The procedure of a resection or anastomosis operations by
means of an intraluminal instrument 20 and an attached housing head
21 attached slide protection device 1 will be described below with
reference to FIGS. 8 and 9.
[0054] Before insertion of the intraluminal instrument 20, the
slide protection device 1 is attached onto the housing head 21 of
the instrument 20. Because of the elastic properties with the
terminal device 2 and the contact feet 10, this can be done on
housing heads 21 with different diameters. The contact surface 13
of the attachment/contact portion 12 lies flat on the end face of
the housing head 21. The two contact feet 10 of the terminal device
2 partially enclose the outer circumference of the housing head
21.
[0055] After the contact pressure device 27 of the intraluminal
instrument 20 has been passed into the proximal portion 30 of the
intestine, as is shown in FIG. 2, the operating surgeon inserts the
intraluminal instrument 20 together with housing head 21 into the
anus and carefully pushes the instrument 20 forward as far as the
intestinal portion where anastomosis is to be performed (generally
the rectal stump). On account of the rounded shape of the slide
protection device 1, which at the same time serves as a cover for
the housing head recess, no mucosal folds are entrained, stretched
and thus damaged. In addition, the terminal device 2 is secured so
as to project over the housing head 21, as a result of which the
sharp edge of the housing head 21 is protected in order to avoid
injuries or the like.
[0056] When inserting and pushing the instrument 20 forward, the
operating surgeon must take care to ensure that the tear-resistant
cords 8 at all times hang out of the anus and do not become knotted
together in the inside of the intestine.
[0057] FIG. 8 shows a diagrammatic view of a housing head 21, with
attached slide protection device 1, advanced as far as the portion
of the intestine on which re-anastomosis is to be performed. The
cords 8 extend from the fastening eyelets 7 in the direction of the
distal end of the intestine.
[0058] Next, as is shown in FIG. 9, the operating surgeon drives
the connection pin 25 out from the inside of the housing head 21
using a rotation device arranged in the grip of the housing. The
tip 26 of the connection pin 25 now passes into the spreader pin
guide recess 14 in the contact surface 13 of the terminal device 2
and, as it is turned out further, it presses the two sections 3 and
4 apart. The pressure which is thus exerted is chosen to be
sufficient to separate the connection by means of the plug-in
bridges 5 of the two sections 3 and 4. Thus, when the connection
pin 25 is turned out sufficiently far, the slide protection device
1 divides into two equal sections 3 and 4. By pulling the cords 8,
it is possible for these two sections 3 and 4 to be removed one
after the other without difficulty from the portion of the
intestine. Since the intestine is slightly stretchable in the
radial direction, the two sections 3 and 4, under a traction force,
slip in between the housing head 21 and the inner wall of the
portion of the intestine and slide in the direction of the anus. In
order to further avoid damage to the intestine or the intestinal
mucous membrane in this direction of movement, all the edges, for
example of the contact feet 10, are of rounded design.
[0059] By removing the slide protection device 1 from the housing
head 21 and from the anastomosis portion, the surgical procedure
according to the introductory part of the description can be
performed in the conventional manner.
[0060] According to a second illustrative embodiment of the present
invention, the connection device 5 extends along the
rotation-symmetrical axis of the terminal device 2. Thus, the
extracted connection pin 25 directly separates the predetermined
break point which is designed advantageously as a plug-in
bridge.
[0061] By means of a third illustrative embodiment, the terminal
device 2 is not made homogeneously of the same elastically
deformable material, but instead as a hollow body which is filled
with a suitable in the inert material.
[0062] Although the present invention has been described above with
reference to preferred illustrative embodiments, it is not limited
to these and instead can be modified in numerous ways.
[0063] For example, the two sections 3 and 4 can be connected only
in a small partial area in an adjoining surface by means of a
connection device.
[0064] With the present invention, a slide protection device is
thus afforded with which medical instruments can be introduced into
and advanced through the portions in question without damaging the
inside of a hollow organ or the mucous membrane contained therein.
In this case, the slide protection device can be removed from the
respective housing head from outside by the operating surgeon and
can be withdrawn from the portion in question. Thus, the slide
protection device does not impede the subsequent important surgical
procedure, i.e. the intestinal anastomosis.
[0065] In addition, it is an advantage that no plastic parts of the
terminal device get into the cutting and clamping mechanism,
because the terminate device is arranged outside on the housing
head.
[0066] FIG. 10 shows a further illustrative embodiment of a slide
protection device according to the invention arranged on a housing
head 21. In this slide protection device, two egg-shaped cap parts
3 and 4 are provided which form the terminal device 2. As is
indicated in FIG. 11, the two cap parts 3 and 4 are connected by
portions of two traction bands 19 at their join 6. The connection
is in this case effected by a releasable adhesive, the traction
band on the inner surface of the cap parts being folded twice
approximately at right angles and finally being fastened securely
in the inside of the cap part perpendicular to the join 6. The
right-angled band connections are likewise made with a releasable
adhesive.
[0067] Each cap part 3, 4 has, at the semicircular lower end, a
contact edge which in the contact position of the terminal device 2
encloses the outer circumference of the housing head 21. Milled
into the inside of each cap part there is a groove 17 with which
each cap part bears on the edge of the housing head 21. Offset by
90.degree. with respect to the join 6, each cap part 3, 4 has an
edge-side traction band guide formation 18 near its end fastening.
The guide formation is designed as a flat groove whose width
corresponds approximately to that of the flat traction band 19.
[0068] After the terminal device 2 from the state shown in FIG. 11
has been placed in the position according to FIG. 10 on the housing
head 21, the traction bands 19 emerge from the egg-cap-shaped
terminal device 2 and are guided in the direction of the grip of
the medical instrument.
[0069] After the described insertion of the instrument 20 through
the anal canal into the portion of the rectum on which anastomosis
is to be performed, and after the desired position has been
reached, each traction band 19 is pulled simultaneously in the
direction of the grip, as a result of which the traction band
folded together at right angles in the cap inner surface unfolds
and slips along the inner surface of the respective cap part in the
direction of the flat edge-side guide formation 18. Thus, the easy
unfolding of the traction band is ensured by the easy release of
the adhesive connection at the join 6 of the two cap parts and by
the easy release of the traction band angles fixed with
adhesive.
[0070] By pulling the traction bands 19 in the direction of the
grip, the two cap parts are opened and are guided along the housing
head 21 in the direction of the grip. The two cap parts are in this
case shaped in such a way that they can slide along the shaft of
the inserted instrument and do not constitute an obstacle upon
removal of the instrument from the anus. The operating surgeon can
now perform the intestinal anastomosis as described.
LIST OF REFERENCE NUMBERS
[0071] 1 slide protection device
[0072] 2 terminal device
[0073] 3 first section
[0074] 4 second section
[0075] 5 web or plug-in bridge
[0076] 6 join between cap parts/half-shells
[0077] 7 fastening eyelet
[0078] 8 traction device
[0079] 9 secure traction band anchoring of upper pole
half-shell
[0080] 10 contact foot
[0081] 11 semicircular band guide
[0082] 12 attachment/contact portion
[0083] 13 contact surface
[0084] 14 spreader pin guide recess
[0085] 15 flattened end
[0086] 16 folded traction band portion at join 6 releasably
bonded
[0087] 17 contact formation or contact edge half-shell
[0088] 18 guide formation
[0089] 19 traction band guide after attachment of closure
device
[0090] 20 intraluminal instrument
[0091] 21 housing head
[0092] 22 housing shaft
[0093] 23 grip
[0094] 24 rotation device
[0095] 25 connection pin
[0096] 26 tip of the connection pin
[0097] 27 contact pressure device
[0098] 28 receiving sleeve
[0099] 29 cutting and clamping mechanism
[0100] 30 proximal portion of the intestine
[0101] 31 distal portion of the intestine
[0102] 32 punched-out ring of tissue
[0103] 33 mucous membrane
[0104] 34 release lever
* * * * *